Nearly one-third of the world's population is obese or overweight, new data show 

This is an image of a weight scale. Credit: CDC/Debora Cartagena

29 may 2014--Today, 2.1 billion people—nearly 30% of the world's population—are either obese or overweight, according to a new, first-of-its kind analysis of trend data from 188 countries. The rise in global obesity rates over the last three decades has been substantial and widespread, presenting a major public health epidemic in both the developed and the developing world.

The study, "Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013," conducted by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and published in The Lancet on May 29, found that the number of overweight and obese individuals globally increased from 857 million in 1980 to 2.1 billion in 2013. Overweight is defined as having a Body Mass Index (BMI), or weight-to-height ratio, greater than or equal to 25 and lower than 30, while obesity is defined as having a BMI equal to or greater than 30.

Over the course of the study, rates of overweight and obesity among adults have increased for both men (from 29% to 37%) and women (from 30% to 38%). In developed countries, men had higher rates of overweight and obesity, while women in developing countries exhibited higher rates. Also in developed countries, the peak of obesity rates is moving to younger ages.

"Obesity is an issue affecting people of all ages and incomes, everywhere," said Dr. Christopher Murray, director of IHME and a co-founder of the Global Burden of Disease (GBD) study. "In the last three decades, not one country has achieved success in reducing obesity rates, and we expect obesity to rise steadily as incomes rise in low- and middle-income countries in particular, unless urgent steps are taken to address this public health crisis."

Looking at individual countries, the highest proportion of the world's obese people (13%) live in the United States. China and India together represent 15% of the world's obese population. Rates in the study were age-standardized, meaning they were adjusted for differences in population size and ages over time and across countries.

Among children and adolescents, obesity has increased substantially worldwide. Between 1980 and 2013, the prevalence of overweight or obese children and adolescents increased by nearly 50%. In 2013, more than 22% of girls and nearly 24% of boys living in developed countries were found to be overweight or obese. Rates are also on the rise among children and adolescents in the developing world, where nearly 13% of boys and more than 13% of girls are overweight or obese. Particularly high rates of child and adolescent obesity were seen in Middle Eastern and North African countries, notably among girls.

"The rise in obesity among children is especially troubling in so many low- and middle-income countries," said Marie Ng, Assistant Professor of Global Health at IHME and the paper's lead author. "We know that there are severe downstream health effects from childhood obesity, including cardiovascular disease, diabetes, and many cancers. We need to be thinking now about how to turn this trend around."

Regionally, countries in the Middle East and North Africa, Central America, and Island nations in the Pacific and Caribbean have already reached exceptionally high rates of overweight and obesity—44% or higher. In 2013, the highest rates of overweight and obesity were seen in the Middle East and North Africa, where more than 58% of men and 65% of women age 20 or older were found to be either overweight or obese. More than two-thirds of the countries in the region had overweight and obesity rates of over 50% in adult men and women. In Central America, more than 57% of adult men and more than 65% of adult women were overweight or obese, with the highest prevalence—greater than 50% among men and women—found in Colombia, Costa Rica, and Mexico. In the Pacific Islands, nearly 44% of men and more than 51% of women are overweight or obese, as are nearly 38% of men and more than 50% of women in the Caribbean.

While the percentage of people who are either overweight or obese has risen substantially over the last 30 years, there have been marked variations across regions and countries. In developed countries, increases in obesity that began in the 1980s and accelerated from 1992 to 2002 have slowed since 2006. Conversely, in developing countries, where almost two-thirds of the world's obese people currently live, increases are likely to continue.

Key findings:

• More than 50% of the world's 671 million obese live in 10 countries (ranked beginning with the countries with the most obese people): US, China, India, Russia, Brazil, Mexico, Egypt, Germany, Pakistan, and Indonesia.
• The US, United Kingdom, and Australia are among the high-income countries with large gains in obesity among men and women.
• Over the 33-year period of research, several countries in the Middle East showed the largest increase in obesity globally. These countries include Bahrain, Egypt, Saudi Arabia, Oman, and Kuwait.
• In six countries, all in the Middle East and Oceania—Kuwait, Kiribati, the Federated States of Micronesia, Libya, Qatar, and Samoa—the prevalence of obesity for women exceeds 50%. In Tonga, both men and women have obesity prevalence over 50%.
• In sub-Saharan Africa, the highest obesity rates (42%) are seen among South African women. Health risks such as cardiovascular disease, cancer, diabetes, osteoarthritis, and chronic kidney disease increase when a person's BMI exceeds 23. In 2010, obesity and overweight were estimated to have caused 3.4 million deaths, most of which were from cardiovascular causes. Research indicates that if left unchecked, the rise in obesity could lead to future declines in life expectancy.

Provided by Institute for Health Metrics and Evaluation

Study proves physical activity helps maintain mobility in older adults

Credit: Peter Griffin/public domain

It's something we've all heard for years: Exercise can help keep older adults healthy. But now a study, the first of its kind to look at frail, older adults, proves that physical activity can help these people maintain their mobility and dodge physical disability.

A new University of Florida study shows daily moderate physical activity may mean the difference between seniors being able to keep up everyday activities or becoming housebound. In fact, moderate physical activity helped aging adults maintain their ability to walk at a rate 18 percent higher than older adults who did not exercise. "The very purpose of the study is to provide definitive evidence that physical activity can truly improve the independence of older adults," said principal investigator Marco Pahor, Ph.D., director of the UF's Institute on Aging.

What's more, moderate physical activity not only helped older adults maintain mobility but also helped prevent the occurrence of long-term mobility loss. Co-principal investigator Jack Guralnik, Ph.D., a professor of epidemiology and public health at the University of Maryland School of Medicine, said there was a 28 percent reduction in people permanently losing the ability to walk easily.

"The fact that we had an even bigger impact on persistent disability is very good," said Guralnik, who also holds a faculty position at UF. "It implies that a greater percentage of the adults who had physical activity intervention recovered when they did develop mobility disability."

The results will be published in the May issue of the Journal of the American Medical Association and will be presented at 1 p.m. Tuesday (May 27) at the annual meeting of the American College of Sports Medicine in Orlando.

Researchers showed that prescribed daily physical activity can prevent older adults' loss of mobility, defined in the study as the ability to walk 400 meters, or about a quarter of a mile. Although 400 meters might sound like an arbitrary number, it's an important figure for older adults, researchers said.

"Four hundred meters is once around the track, or from the parking lot to the store, or two or three blocks around your neighborhood," Guralnik said. "It's an important distance in maintaining an independent life." Called the Lifestyle Interventions and Independence for Elders, or LIFE, study, the study took place across eight field centers. There were two Florida field center recruitment sites at the University of Florida and Jacksonville Brooks Rehabilitation as well as field centers at Northwestern University, Pennington Biomedical Research Center, the University of Pittsburgh, Stanford University, Tufts University, Wake Forest School of Medicine and Yale University.

The researchers recruited 1,635 sedentary men and women ages 70 to 89 for the study. The participants could walk a quarter mile within 15 minutes but were at risk of losing that ability. Low physical performance can be a predictor of early death and higher hospitalization and institutionalization rates, and patients with low physical performance are not often recruited to large studies, Pahor said.

"These are people who are patients we see every day. This is why this study is so important: It includes a population that is typically understudied," Pahor said.

The participants were randomly separated into two groups and followed for an average of 2.6 years. The first group of 818 walked 150 minutes per week and did strength, flexibility and balance training. They were monitored by two visits to field centers per week. The second group of 817 attended health education classes and performed stretching exercises. This phase of the study occurred between February 2010 and December 2013.

Staff members assessed study participants every six months, checking their ability to walk, their body weight, blood pressure and pulse rate, among other measurements. The staff was not told which participants were assigned to physical activity or to the education classes.

The study did turn up one unanticipated result: The number of people reporting hospitalizations in the physical activity group was slightly higher than in the education group, though the number was not statistically significant. The researchers think this is in part because the physical activity group had more frequent contact with research staff, possibly resulting in a higher reporting of hospitalizations. The physical activity could also have triggered underlying heart trouble and other health problems. Researchers plan to study this occurrence more closely, Pahor said.

"It's quite a vulnerable and high-risk population," Pahor said. "Both age and poor health were factors. We selected people who had low physical performance, which is a strong predictor for future morbidity, hospitalization, institutionalization and mortality."

Wendy Kohrt, Ph.D., professor of medicine in the division of geriatric medicine at the University of Colorado, helped review the scientific merit of the study before the launch of the main LIFE trial. She said the information produced by this study fills gaps in researchers' knowledge of the types of people enrolled in the study.

"As an exercise scientist, I believe this type of research is absolutely critical to establish scientific evidence on which to make recommendations for how lifestyle can beneficially influence health status," Kohrt said. "There is a general belief among the public and the scientific and medical communities that we know exercise is good for you, so why do we need to do more research in this area? However, we still do not know whether certain types or doses of exercise are better than others, particularly for specific health conditions or diseases. The LIFE trial demonstrated that a modest increase in physical activity has the potential to help older adults maintain functional independence."

Pahor and Guralnik said there is still a vast amount of data to unpack from the study, including looking at the effects of physical activity on the participants' emotional well-being. The research team also plans to determine how physical activity impacted the participants' physiological, social and biological factors.

Research shows why ketamine is an effective antidepressant but memantine is not

One 10 ml vial of 1000 mg ketamine. Credit: Psychonaught/Wikipedia

27 may 2014—Ketamine is a fast-acting antidepressant. However, it can create symptoms that mimic psychosis. Therefore, doctors don't give it to depressed patients. Memantine, a similar drug, does not have psychotomimetic effects, but it also does not appear to alleviate depression. Lisa M. Monteggia of the University of Texas Southwestern Medical Center and her colleagues have determined that these drugs have different effects on neurotransmitter pathways. In particular, ketamine promotes the expression of neurotrophic factors but memantine doesn't. The research appears in the Proceedings of the National Academy of Sciences.

Traditional antidepressants target the monoamine system. Patients who take them require several weeks of treatment before they begin to feel an effect. In some cases, for example, if the patient is suicidal, waiting this long can be dangerous. A fast-acting antidepressant would be a preferable treatment.

Ketamine is such a fast-acting drug. Patients have reported experiencing its antidepressant effects within 30 minutes to a few hours after a single intravenous dose. Unlike traditional antidepressants, ketamine does not affect the monoamine system. It is an NMDA receptor antagonist. Unfortunately, it can cause psychotic symptoms; therefore, doctors do not prescribe it for treatment of depression.

As an alternative to ketamine, pharmacologists have considered using the drug memantine, another NMDA receptor antagonist. Memantine, used to treat patients with Alzheimer's disease, does not cause psychotic symptoms and therefore would be safer to use. Clinical studies, however, have shown that it does not behave as an antidepressant. Until now, researchers haven't understood why.

To understand the differences between these two drugs, Monteggia's team first tested their antidepressant properties on mice. Tests confirmed previous observations that ketamine acts as an antidepressant but memantine does not.

The team then used electrophysiology to examine the effect of ketamine and memantine on cultured mouse hippocampal neurons. They found key functional differences in how the drugs suppress NMDA receptor function at rest and how they inhibit the eukaryotic elongation factor 2 kinase (eEF2K) signaling pathway.

When the extracellular recording solution did not contain magnesium, both ketamine and memantine antagonized NMDA receptors. However, with the addition of magnesium, ketamine blocked NMDA receptors, but memantine did not. In addition, ketamine inhibited the phosphorylation of eeF2 and augmented expression of brain derived neurotrophic factor (BDNF). Memantine did not produce these effects. Augmentation of BNDF makes ketamine an effective antidepressant.

These findings could help scientists develop new, fast-acting antidepressants with fewer side effects.

More information: Mechanisms underlying differential effectiveness of memantine and ketamine in rapid antidepressant responses, PNAS, 2014. www.pnas.org/cgi/doi/10.1073/pnas.1323920111

Team explores broader definition of successful aging

An aging population poses challenges for governments around the globe as nations grapple with how to satisfy the physical, social and economic needs of older adults. About 126 million adults 65 years and older live in China - the country with the largest population of senior citizens, while 40 million adults 65 years and older live in the United States.

27 may 2014--In an article published today in Journal of Transcultural Nursing, University of Louisville School of Nursing assistant professor Valerie Lander McCarthy, PhD, RN; Ji Hong, MSN, a visiting scholar from Shandong University, China; and Jiying Ling, PhD, MS, RN, post-graduate fellow, Michigan State University College of Nursing, explore whether a broader definition of successful aging could positively influence research, clinical practice and health policy in the United States and China.

McCarthy argues it is unrealistic to measure positive aging solely on good physical and cognitive function and active social engagement, as traditionally defined by J. W. Rowe, M.D., and Robert L. Kahn.

"In reality the definition applies to only about 10-percent of the older adult population, then older adults feel guilty when they get sick because they think they are not succeeding – and in the U.S. succeeding is important. In China, individual success is not as important, but the negative effect of the cost to care for the older population is a major problem," McCarthy said.

Even in the presence of chronic illness and functional limitations, older adults still report aging successfully, McCarthy said. She concludes nurse scientist Meredith Flood's definition is most accurate. Flood describes successful aging as a person's ability to cope and adapt while maintaining a sense of connectedness and meaning in life.

Building on Flood's ideas, McCarthy's own studies have found transcendence - a sense of meaning, well-being and life satisfaction, to be the best predictor of positive aging. The concept involves relationships, creativity, contemplation, introspection and spirituality. Thanks to a grant from the nursing honor society Sigma Theta Tau International and the National Gerontological Nurses Association, she is working to develop a program of activities to increase transcendence.

An example of one intervention involves a time for quiet solitude in natural beauty followed by a discussion about a person's outlook, helping to develop a broadened perspective on life or a feeling of being an integral part of the cycle of life. A second example may provide an opportunity for storytelling, increasing a sense of belonging to a group.

"Successful aging is important for the rapidly growing population of older adults and their families and caregivers," McCarthy said. "It also is significant for society as a whole, which will bear the burden of unprecedented demands on health and social services. This is one reason we are developing interventions to increase positive aging."

More information: tcn.sagepub.com/content/early/2014/05/16/1043659614526257.full.pdf

Provided by University of Louisville

Being Sardinian puts a smile on the face of the elderly

Residents of the Italian island of Sardinia are known for their longevity. Now, a new study also shows that elderly Sardinians are less depressed and generally are in a better mental frame of mind than peers living elsewhere. The study, led by Maria Chiara Fastame and Maria Pietronilla Penna of the University of Cagliari in Italy and Paul Hitchcott from the Southampton Solent University in UK, is published in Springer's journal Applied Research in Quality of Life.

26 may 2014--Various tests to measure the mental state and capacity of elderly people were performed on 191 cognitively healthy native-born residents between the ages of 60 years and 99 years old. They were recruited from the rural areas of Lombardy in Northern Italy, from the Sardinian city of Sassari and the agro-pastoral villages of Bargagia and Ogliastra on the Mediterranean island. These areas were chosen because of the high prevalence of centenarians who live on the isle. Fastame and colleagues showed in a previous study that residents from Ogliastra enjoy greater levels of psychological well-being than those of Lombardy. Her team now wanted to find out if depression among the elderly was influenced by factors such as gender, marital status, age, lifestyle choices, levels of brain functioning and the environment.

Findings from the latest study highlight the effect that one's region of residence has on psychological well-being. It was noted that the Sardinian way of life trumps all else, with older Sardinians being less depressed and experiencing higher levels of personal satisfaction and coping strategies than is true for the norm. In contrast, the elderly from Northern Italy struggled with depression.

These findings are ascribed to the fact that elderly people from Sardinia, and especially those from Ogliastra, are physically active until late in life and feel more valued, respected and supported by younger generations. In turn, elderly Sardinians living in Sassari benefit from higher levels of wealth and physical health. They have mental health services nearby, and are involved in ongoing social, recreational and cultural activities.

More symptoms of depression were noted among women than men; and city dwellers reported more symptoms of depression than those from rural areas. Also, very old participants between 75 and 99 years old tended to be more depressed than those between 65 and 74 years old.

The researchers expressed worry about the marked signs of depression noted among residents of Northern Italy. They advise that psychology-based intervention programs be implemented to help strengthen the self-image and self-esteem of the elderly living in these areas, to ultimately improve the quality of their later life and to ward off feelings of depression.

"Positive ageing is more evident in Sardinia, especially in rural areas, where the maintenance of an adequate social status and physical activity help guarantee a positive level of mental health in later life," conclude Fastame and her colleagues.

More information: Fastame, M.C. et al (2014). Mental Health in Late Adulthood: What Can Preserve It? Applied Research in Quality of Life. DOI: 10.1007/s11482-014-9323-5

Provided by Springer

Medical conditions add to premature mortality risk of people with mental illness

Dr Ruth Cunningham

24 may 2014—People using mental health services in New Zealand are dying prematurely from both natural and external causes, a new University of Otago Wellington study has revealed.

While suicide and accidents are contributors to these high death rates, chronic medical conditions such as heart disease and cancer are a significant cause, the study has found.

Published today in the New Zealand Medical Journal, the study of 266,093 people who had contact with mental health services between 2002 and 2010 shows that the death rate for people who experience mental health problems severe enough to lead to contact with psychiatric services is twice that of the total population.

People with the most severe mental illnesses such as schizophrenia and bipolar disorder have three times the overall death rate of the total population, the study shows.

Lead author Dr Ruth Cunningham says the findings highlight the need to understand and meet the physical health needs of people with mental illness.

More than 7000 adults who had used mental health services died before the age of 65 during the study period. The main cause of death for both women and men were natural (71% and 58% respectively), due mainly to cancer and heart disease. Suicide accounted for 15% of deaths in women and 22% of deaths in men, and accidents were also common, Dr Cunningham says.

High smoking rates and antipsychotic medications are recognised health risks for people with mental illness that lead to medical conditions such as cancer and heart disease, but there are other less obvious risks, such as lack of appropriate treatment for medical conditions, that need to be acknowledged and addressed, she says.

Discrimination and social deprivation will also be contributing to the mortality gap, she adds.

"For example, both here and overseas, people using mental health services are saying they experience discrimination by health service providers. This can lead to a lack of adequate preventative care and treatment."

Discrimination can occur against anyone with mental illness, especially those with severe mental illness, and can make it extremely difficult to secure a job and decent housing, which further impacts on health, Dr Cunningham says.

"We found that those using mental health services were more likely to be living in socially deprived areas, which also drives up the risk of premature death."

This critical health issue has been well researched internationally, but this is the first time it has been documented in New Zealand, Dr Cunningham says.

The next step must be coordinated action to address these health inequalities, through initiatives such as the "Equally Well" project, which was initiated in September 2013 by Te Pou and Platform Trust, she says.

"Equally Well" is a New Zealand initiative which has been gathering evidence on the extent of physical health problems for people with a severe mental illness and/or addiction, including the results of this study. Its next phase will focus on coordinating action across key organisations, including medical colleges, and government and non-government agencies, to improve the physical health outcomes of people with a severe mental illness and/or addiction.

Ongoing monitoring of the physical health and mortality of people with mental illness is essential, in order to evaluate the effectiveness of any interventions and to ensure that the health of this group is no longer neglected, Dr Cunningham says.

Provided by University of Otago

Newly separated most at risk of suicidal thoughts

Credit: Lloyd Morgan on flickr

Men and women are most likely to have suicidal thoughts within a year of a marriage or de-facto relationship breakup, new ANU research has found.

23 may 2014--The vulnerability may be due to the trauma of the breakup, along with subsequent changes in social networks affecting people's sense of belonging, said lead author of the study Dr Philip Batterham, from the ANU Centre for Mental Health Research.

"The prevalence of suicidal thoughts among recently separated men and women is three times higher than for those who remain married, or in de-facto relationships," he said.

He said the study highlights the need for governments and health services to better target mental health services to people who have recently separated from a marriage or a relationship.

"It is important to intervene early, to reduce suicidal thoughts and suicidal behaviours, before they end up as a suicide," he said.

Dr Batterham's study began in 2000 and has looked at more than 6,600 people aged between 20 and 64 from Canberra and nearby Queanbeyan. The study investigated whether periods before and after a relationship breakup presented increased risk of suicidal thoughts and behaviours.

Follow up interviews will continue every four years, until 2020.

Results found the period up to four years before a separation was also a time of increased risk. However, suicidal thoughts were more prevalent after a relationship break up.

Suicidal thoughts and behaviour were most common among people aged in their 20s, and lowest for those in their 60s. The 20s age group also reported a higher number of more recent and impending separations.

Rates of suicidal thoughts began to fall gradually among those in their second year of separation. After five years or more after separation, the risk further declined, but remained 'significantly elevated, Batterham said.

The study was conducted by researchers at the Centre for Mental Health Research and the Centre for Research on Ageing, Health and Wellbeing at the Australian National University, with support from a number of other Australian researchers linked through the NHMRC Centre of Research Excellence in Suicide Prevention.

Findings are to be published in the June edition of Social Science & Medicine.

Provided by Australian National University

Swiss organisation extends assisted suicide to elderly

A Swiss assisted suicide group has expanded its services to help elderly patients who are sick but not terminally ill end their lives, it said Thursday.

23 may 2014--Exit A.D.M.D., a group that provides assisted suicide in the French-speaking part of Switzerland, officially broadened the scope of who it can help during its general assembly last month, its leader Doctor Jerome Sobel told AFP.

The group's larger sister organisation, Exit, which operates in the German and Italian speaking parts of the country, is planning to follow suit in a few days, he added.

"We are helping people who are sick and opt for quality of life over a quantity of time surviving with a poor quality of life," Sobel said, insisting the organisation's activities remained "well within Swiss law."

"Passive" assisted suicide has been legal in Switzerland since the 1940s, provided the person is in his or her right mind and anyone helping them is not motivated by self-interest or financial gain.

A number of groups work to help the terminally ill and those suffering who wish to end their lives to do so, usually by supplying them with a lethal dose of a drug they must administer themselves.

Exit A.D.M.D., which only assists in suicides for people who live in Switzerland, helped 155 people—mainly terminally ill cancer patients—end their lives last year.

Exit helped 459 people end their lives in 2013.

Sobel said the membership of his group is ageing and many people had demanded that it officially include the infirm but not terminally ill elderly among those it is willing to help.

He said that if a person over the age of 75, who is for example already deaf and going blind, "calls us and asks us to help them, we will help them."

"If we don't, some might accuse us of abusing them, since forcing them to continue living can be torture," he explained.

Last year, the European Court of Human Rights called on Switzerland to clarify the guidelines for assisted suicide after an octogenarian who wanted to end her life failed to convince doctors to assist her because she was not ill enough.

Sobel said his group's decision to broaden the official scope of who to assist in dying had not been impacted by that case.

© 2014 AFP

Cognitive test can differentiate between Alzheimer's and normal aging

Jim Monti (right), a postdoctoral research associate in the lab of Illinois psychology professor Neal Cohen (left), developed a cognitive task that helps differentiate older adults with very early Alzheimer's disease from those experiencing normal aging. Credit: L. Brian Stauffer

22 may 2014--Researchers have developed a new cognitive test that can better determine whether memory impairments are due to very mild Alzheimer's disease or the normal aging process.

Their study appears in the journal Neuropsychologia.

The Alzheimer's Association estimates that the number of Americans living with Alzheimer's disease will increase from 5 million in 2014 to as many as 16 million by 2050. Memory impairments and other early symptoms of Alzheimer's are often difficult to differentiate from the effects of normal aging, making it hard for doctors to recommend treatment for those affected until the disease has progressed substantially.

Previous studies have shown that a part of the brain called the hippocampus is important to relational memory – the "ability to bind together various items of an event," said Jim Monti, a University of Illinois postdoctoral research associate who led the work with psychology professor Neal Cohen, who is affiliated with the Beckman Institute at Illinois. Being able to connect a person's name with his or her face is one example of relational memory. These two pieces of information are stored in different parts of the brain, but the hippocampus "binds" them so that the next time you see that person, you remember his or her name, Monti said.

Previous research has shown that people with Alzheimer's disease often have impairments in hippocampal function. So the team designed a task that tested participants' relational memory abilities.

Researchers asked participants to study a circle divided into three patterned parts then pick an exact match from a series of 10 other circles. This task measures the performance of a part of the brain called the hippocampus, which has been shown to sustain damage in Alzheimer's disease. Credit: Jim Monti

Participants were shown a circle divided into three parts, each having a unique design. Similar to the process of name-and-face binding, the hippocampus works to bind these three pieces of the circle together. After the participants studied a circle, they would pick its exact match from a series of 10 circles, presented one at a time.

People with very mild Alzheimer's disease did worse overall on the task than those in the healthy aging group, who, in turn, did worse than a group of young adults. The task also revealed an additional memory impairment unique to those with very mild Alzheimer's disease, indicating the changes in cognition that result from Alzheimer's are qualitatively different than healthy aging. This unique impairment allows researchers to statistically differentiate between those who did and those who did not have Alzheimer's more accurately than some of the classical tests used for Alzheimer's diagnosis, Monti said.

"That was illuminating and will serve to inform future work aimed at understanding and detecting the earliest cognitive manifestations of Alzheimer's disease," Monti said.

Although this new tool could eventually be used in clinical practice, more studies need to be done to refine the test, he said.

"We'd like to eventually study populations with fewer impairments and bring in neuroimaging techniques to better understand the initial changes in brain and cognition that are due to Alzheimer's disease," Monti said.

More information: The paper, "Very mild Alzheimer's disease is characterized by increased sensitivity to mnemonic interference" is available online: www.sciencedirect.com/science/article/pii/S0028393214001213

Provided by University of Illinois at Urbana-Champaign

USPSTF: Evidence lacking for primary care suicide screening

21 may 2014-The U.S. Preventive Services Task Force (USPSTF) has concluded that the current evidence is insufficient to evaluate the balance of benefits and harms of suicide screening in the primary care setting. These findings are presented in a final recommendation statement published in the May 20 issue of the Annals of Internal Medicine.

Michael L. LeFevre, M.D., M.S.P.H., on behalf of the USPSTF, updated the 2004 recommendation on screening for suicide risk. Researchers from the USPSTF reviewed the literature for the accuracy and reliability of suicide screening instruments; benefits and harms of screening for risk; and benefits and harms of treatments to prevent suicide.

Based on the current evidence, the researchers concluded that the balance of benefits and harms of screening for suicide risk cannot be assessed. The recommendation applies to adolescents, adults, and older adults without psychiatric disorders, in the primary care setting.

"More research is needed to better understand current screening tests, to develop new ones that can better identify people without symptoms who are at risk for suicide, and to create effective treatment programs for those who are identified ashigh risk," Task Force member Linda Baumann, Ph.D., said in a statement.

More information: Full Text

Grand-parenting keeps wheels turning

Grandparenting can improve cognitive function. Credit: Telegraph.co.uk

19 may 2014--—Postmenopausal women who took care of their grandchildren one day a week had better memory and faster cognitive speed than those who didn't, according to new research from the University of Melbourne.

The researchers however have a warning about over-using the generous nature of grandparents noting that women who cared for grandchildren five or more days a week had significantly slower processing speed and planning scores, possibly because they felt exhausted.

Results came from the Women's Healthy Ageing Project (WHAP) a longitudinal prospective study of more than 20years in Melbourne women. Director of WHAP, Associate Professor Cassandra Szoeke from the Faculty of Medicine, Dentistry and Health Sciences, said it is important to study the impact of grand-parenting on cognition.

"Social engagement, positive mood enhancement, ongoing learning and mental stimulation have all been shown to reduce the likelihood of getting Alzheimer's Disease. These are all important elements for warding off dementia and grand- parenting contains all these components," she said.

There is an increasing reliance on grandparents for childcare assistance in dual income families, so it is important to examine the impact for grandparents.

It was noted that women who were looking after their grandchildren five days a week, were more likely to report they felt demand from their children than the other women. Anxiety and stress can impair cognitive performance. Associate Professor Szoeke and her colleagues are now looking further into this.

Associate Professor Szoeke believes it is important to focus more on our health in later life, rather than disease and lack of function.

"Older people make significant contributions to our community, with the number of people who will live to over 100 estimated to rise globally by 1000%by 2050. The time to explore healthy ageing is now."

Provided by University of Melbourne

Why athletes are more likely to need pacemakers in old age

A new study by The University of Manchester has shed light on why athletes are more likely to have abnormal heart rhythms.

18 may 2014--Elderly athletes with a lifelong history of training and competing in endurance events like marathons, triathlons and iron man challenges can have heart rhythm disturbances, known as arrhythmias.

The Manchester research in rodents, funded by the British Heart Foundation, shows molecular changes in the heart's pacemaker occur in response to exercise training.

The finding, reported in Nature Communications, overturns the commonly held belief that an increased activity of the autonomic nervous system causes this specific reaction to endurance training.

While normal adults have resting heart rates between 60-100 beats per minute, hearts of endurance athletes can beat only 30 times per minute or even lower at night time when there can be long pauses between heart beats.

Cyclists Sir Chris Hoy and Miguel Indurain reportedly had resting heart rates of 30 and 28 beats per minute.

Dr Alicia D'Souza, from The University of Manchester and first author on the paper, said: "The heart rate is set by the heart's pacemaker, but this is controlled by the nervous system. The 'vagal' nerves lower the heart rate and therefore it was assumed the low heart rate of athletes is the result of over activity of the vagal nerves.

"But our research shows this is not the case. Actually the heart's pacemaker changes in response to training and in particular there is a decrease in an important pacemaker protein, known as HCN4, and this is responsible for the low heart rate."

The researchers say these molecular changes in the sinus node - the cardiac structure responsible for generating heart rhythm - may help us to understand the more frequent occurrence of heart rhythm disturbances or even loss of consciousness in athletes.

Professor Mark Boyett, lead researcher on the study, added: "This is important because although normally a low resting heart rate of an athlete does not cause problems, elderly athletes with a lifelong training history are more likely to need an artificial electronic pacemaker fitted."

More than 500 marathons take place in Europe and America each year with around one million participants. The number of people taking part is set to increase by 5% each year.

But Professor Boyett said: "Although endurance exercise training can have harmful effects on the heart, it is more than outweighed by the beneficial effects."

Professor Jeremy Pearson, Associate Medical Director at the British Heart Foundation, said: "This study shows the heart's electrical wiring changes in mice that exercise for long periods, and these changes in heart rhythm are sustained afterwards.

"If the findings are reproduced in humans they could have implications for heart health in older athletes. But much more research is needed before we could draw that conclusion."

More information: Paper: dx.doi.org/10.1038/ncomms4775

Provided by University of Manchester

New early warning system predicts dengue fever risk during the soccer World Cup in Brazil

For the first time, scientists have developed an early warning system to predict the risk of dengue infections for the 553 microregions of Brazil during the football World Cup. The estimates, published in The Lancet Infectious Diseases, show that the chance of a dengue outbreak is enough of a possibility to warrant a high-alert warning in the three northeastern venues (Natal, Fortaleza, and Recife) but is likely to be generally low in all 12 host cities.

17 may 2014--Dengue is a viral infection that is transmitted between humans by Aedes aegypti mosquitoes. In some cases, it causes life-threatening illness. There are currently no licensed vaccines or treatments against dengue. So far this century, Brazil has recorded more cases of dengue fever than anywhere else in the world, with more than 7 million cases reported between 2000 and 2013.

"Recent concerns about dengue fever in Brazil during the World Cup have made dramatic headlines, but these estimates have been based solely on averages of past dengue cases. The possibility of a large dengue fever outbreak during the World Cup, capable of infecting visitors and spreading dengue back to their country of origin, depends on a combination of many factors, including large numbers of mosquitoes, a susceptible population, and a high rate of mosquito-human contact", explains lead author Dr Rachel Lowe from the Catalan Institute of Climate Sciences in Barcelona, Spain.

In particular, climate has an important effect on dengue transmission in epidemic-prone areas where temperature and rainfall drive both mosquito and virus transmission dynamics. The risk of an epidemic increases shortly after a season of heavy rainfall, as occurred in the Amazon during the summer in Brazil.

"Our aim was to take the available evidence on real-time seasonal rainfall and temperature forecasts, transmission dynamics, and social and environmental variables (e.g., urbanisation), and combine it with the latest in mapping and mathematical modelling to produce robust risk estimates for the 12 host cities where matches will be played", says Dr Lowe.

The researchers estimate little risk of dengue outbreaks during the forthcoming World Cup period in the southern and central capitals of Brasília, Cuiabá, Curitiba, Porto Alegre, and São Paulo. However, they predict that there is some chance of dengue risk exceeding medium levels in Rio de Janeiro, Belo Horizonte, Salvador and Manaus. The three cities with the highest risk are Natal, Fortaleza, and Recife, although the risk still remains relatively low.

According to Dr Lowe, "The ability to provide early warnings of dengue epidemics at the microregion level, three months in advance, is invaluable for reducing or containing an epidemic and will give local authorities the time to combat mosquito populations in those cities with a greater chance of dengue outbreaks."

Writing in a linked Comment, David Harley and Elvina Viennet from the Australian National University in Canberra, Australia say, "Travellers, particularly those attending matches in high-risk cities, identified as Recife, Fortaleza, and Natal by Lowe and colleagues, might return home with dengue… Those who return home unwell will seek treatment. Doctors must be aware of causes for febrile illness in World Cup spectators… We expect that few spectators will originate from tropical low-income and middle-income countries, and those who do will probably be wealthy, able to access good medical care, and likely to protect themselves from mosquito bites. Even in those who infect mosquitoes on their return, most will live in dengue endemic countries where the introduction of Brazilian dengue virus will make little difference to local epidemiology. Perhaps a few will return to tropical centres in wealthy countries where A aegypti is present but where the incidence of dengue is low. One such example is Cairns in far north Queensland, Australia, where dengue epidemics causally linked to, but geographically distant from, the World Cup in Brazil are possible."

More information: www.thelancet.com/journals/lancetid/article/PIIS1473-3099(14)70781-9abstract

Provided by Lancet

Patients most in need of the vaccine against shingles don't get it

People at the highest risk of shingles are those with immunosuppressive conditions (such as HIV) but they are not entitled to vaccination due to safety concerns, suggests a paper published in BMJ today.

16 may 2014--Researchers say alternative strategies are needed to reduce the risk of shingles among these patient groups.

Shingles is a common disease among older individuals which causes an acute painful rash and can lead to a complication (called postherpetic neuralgia) resulting in pain lasting from months to years that can significantly impair a person's quality of life.

Researchers from the London School of Hygiene & Tropical Medicine used data from over 144,000 UK adults diagnosed with shingles between 2000 and 2011, and compared this with a group of patients without shingles, to explore whether patients with certain medical conditions may be at increased risk of developing shingles.

The median age at shingles diagnosis was found to be 62 years and around 60% of patients were female.

A number of relatively common conditions were associated with an increased risk of shingles. People with rheumatoid arthritis, chronic obstructive pulmonary disease, or inflammatory bowel disease were 30-50% more likely to have a shingles diagnosis, than individuals without these conditions. Other common medical conditions which were associated with a smaller increase in shingles risk were asthma, chronic kidney disease, type 1 diabetes and depression.

Among those with some of these medical conditions the increased risk of shingles appeared to be greater among younger individuals. But because shingles is less common in younger individuals their absolute risk of developing shingles remains low.

A shingles vaccine is currently available and licensed among individuals aged over 50. Further research would be required to establish whether vaccination is warranted in patients with these medical conditions, particularly those in younger age groups not currently targeted to receive the vaccine; these individuals are less likely to develop long-term pain and complications from shingles.

However the researchers emphasise that those at the highest risk of shingles remain patients with conditions causing severe immunosuppression (such as HIV and leukaemia); for example patients with HIV were five times as likely to develop shingles compared to individuals without HIV. Such patients are currently not eligible for vaccination due to safety concerns. The researchers therefore say this study highlights the need to identify strategies to reduce the risk of shingles among patients with severe immunosuppression.

More information: Paper: Quantification of risk factors for herpes zoster: population based case-control study, BMJ, 2014.

Provided by British Medical Journal

Students views on being a 'good' doctor versus a 'professional' doctor

15 may 2014--—In light of previous research which found that medical students valued compassion, patient-centred care and communication skills over clinical competence and knowledge, new research has sought to further explore medical students' views on professionalism.

Forty-nine medical students took part in 13 focus groups conducted by researchers from The University of Western Australia based at the Rural Clinical School of Western Australia and the School of Medicine and Pharmacology.

Differences between students' understandings of the 'good' and 'professional' doctor were observed. Being competent, a good communicator and a good teacher were the main characteristics of the 'good' doctor. Professionalism was strongly associated with the adoption of a professional persona; following a code of practice and professional guidelines, and treating others with respect were also associated with the 'professional' doctor.

Lead author Dr Beatriz Cuesta-Briand said the results published in BMC Medical Education suggest students felt more connected to the notion of the 'good' doctor and perceived professionalism as an external and imposed ideal.

"When both constructs were seen as acting in opposition, students tended to forgo professionalism in favour of becoming a 'good' doctor," Dr Cuesta-Briand said. "There were areas of overlap however and students clearly honoured elements that are core to professionalism. These areas of overlap should be a starting point upon which medical educators can build on discussion about professionalism."

Data for the qualitative study was collected through focus groups conducted with students who were in the clinical years (fourth to sixth year) of The University of Western Australia (UWA) MBBS program.

In fourth year, professionalism is taught through a series of lectures and face-to-face meetings with a Personal and Professional Development (PPD) mentor; in fifth year, the PPD program runs throughout the year and is formally assessed through reflective portfolio tasks, whilst in sixth year, professionalism is assessed through a case-based ethics essay.

Provided by University of Western Australia

Having a sense of purpose may add years to your life, study finds

Feeling that you have a sense of purpose in life may help you live longer, no matter what your age, according to research published in Psychological Science, a journal of the Association for Psychological Science.

13 may 2014--The research has clear implications for promoting positive aging and adult development, says lead researcher Patrick Hill of Carleton University in Canada:

"Our findings point to the fact that finding a direction for life, and setting overarching goals for what you want to achieve can help you actually live longer, regardless of when you find your purpose," says Hill. "So the earlier someone comes to a direction for life, the earlier these protective effects may be able to occur."

Previous studies have suggested that finding a purpose in life lowers risk of mortality above and beyond other factors that are known to predict longevity. But, Hill points out, almost no research examined whether the benefits of purpose vary over time, such as across different developmental periods or after important life transitions.

Hill and colleague Nicholas Turiano of the University of Rochester Medical Center decided to explore this question, taking advantage of the nationally representative data available from the Midlife in the United States (MIDUS) study.

The researchers looked at data from over 6000 participants, focusing on their self-reported purpose in life (e.g., "Some people wander aimlessly through life, but I am not one of them") and other psychosocial variables that gauged their positive relations with others and their experience of positive and negative emotions.

Over the 14-year follow-up period represented in the MIDUS data, 569 of the participants had died (about 9% of the sample). Those who had died had reported lower purpose in life and fewer positive relations than did survivors.

Greater purpose in life consistently predicted lower mortality risk across the lifespan, showing the same benefit for younger, middle-aged, and older participants across the follow-up period.

This consistency came as a surprise to the researchers:

"There are a lot of reasons to believe that being purposeful might help protect older adults more so than younger ones," says Hill. "For instance, adults might need a sense of direction more, after they have left the workplace and lost that source for organizing their daily events. In addition, older adults are more likely to face mortality risks than younger adults."

"To show that purpose predicts longer lives for younger and older adults alike is pretty interesting, and underscores the power of the construct," he explains.

Purpose had similar benefits for adults regardless of retirement status, a known mortality risk factor. And the longevity benefits of purpose in life held even after other indicators of psychological well-being, such as positive relations and positive emotions, were taken into account.

"These findings suggest that there's something unique about finding a purpose that seems to be leading to greater longevity," says Hill.

The researchers are currently investigating whether having a purpose might lead people to adopt healthier lifestyles, thereby boosting longevity.

Hill and Turiano are also interested in examining whether their findings hold for outcomes other than mortality.

"In so doing, we can better understand the value of finding a purpose throughout the lifespan, and whether it provides different benefits for different people," Hill concludes.

More information: All data and materials have been made publicly available via the Interuniversity Consortium for Political and Social Research and can be accessed at the following URLs: doi.org/10.3886/ICPSR04652.v6 andmidus.colectica.org/ . The complete Open Practices Disclosure for this article can be found at pss.sagepub.com/content/by/supplemental-data .

This article has received badges for Open Data and Open Materials. More information about the Open Practices badges can be found at osf.io/tvyxz/wiki/view/ and pss.sagepub.com/content/25/1/3.full .

The article abstract are available online: pss.sagepub.com/content/early/2014/05/06/0956797614531799.abstract

Provided by Association for Psychological Science

Diets rich in antioxidant resveratrol fail to reduce deaths, heart disease or cancer

Skeletal formula of trans-resveratrol. Image: Wikipedia

A study of Italians who consume a diet rich in resveratrol—the compound found in red wine, dark chocolate and berries—finds they live no longer than and are just as likely to develop cardiovascular disease or cancer as those who eat or drink smaller amounts of the antioxidant.

12 may 2014--"The story of resveratrol turns out to be another case where you get a lot of hype about health benefits that doesn't stand the test of time," says Richard D. Semba, M.D., M.P.H., a professor of ophthalmology at the Johns Hopkins University School of Medicine and leader of the study described May 12 in JAMA Internal Medicine. "The thinking was that certain foods are good for you because they contain resveratrol. We didn't find that at all."

Despite the negative results, Semba says, studies have shown that consumption of red wine, dark chocolate and berries does reduce inflammation in some people and still appears to protect the heart. "It's just that the benefits, if they are there, must come from other polyphenols or substances found in those foodstuffs," he says. "These are complex foods, and all we really know from our study is that the benefits are probably not due to resveratrol."

The new study did not include people taking resveratrol supplements, though few studies thus far have found benefits associated with them.

Semba is part of an international team of researchers that for 15 years has studied the effects of aging in a group of people who live in the Chianti region of Italy. For the current study, the researchers analyzed 24 hours of urine samples from 783 people over the age of 65 for metabolites of resveratrol. After accounting for such factors as age and gender, the people with the highest concentration of resveratrol metabolites were no less likely to have died of any cause than those with no resveratrol found in their urine. The concentration of resveratrol was not associated with inflammatory markers,cardiovascular disease or cancer rates.

Semba and his colleagues used advanced mass spectrometry to analyze the urine samples.

The study participants make up a random group of people living in Tuscany where supplement use is uncommon and consumption of red wine—a specialty of the region—is the norm. The study participants were not on any prescribed diet.

Resveratrol is also found in relatively large amounts in grapes, peanuts and certain Asiatic plant roots. Excitement over its health benefits followed studies documenting anti-inflammatory effects in lower organisms and increased lifespan in mice fed a high-calorie diet rich in the compound.

The so-called "French paradox," in which a low incidence of coronary heart disease occurs in the presence of a high dietary intake of cholesterol and saturated fat in France, has been attributed to the regular consumption of resveratrol and other polyphenols found in red wine.

More information: JAMA Intern Med. Published online May 12, 2014. DOI: 10.1001/jamainternmed.2014.1582

Provided by Johns Hopkins University School of Medicine

Religion, spirituality influence health in different but complementary ways

Religion and spirituality have distinct but complementary influences on health, new research from Oregon State University indicates.

12 may 2014--"Religion helps regulate behavior and health habits, while spirituality regulates your emotions, how you feel," said Carolyn Aldwin, a gerontology professor in the College of Public Health and Human Sciences at OSU.

Aldwin and colleagues have been working to understand and distinguish the beneficial connections between health, religion and spirituality. The result is a new theoretical model that defines two distinct pathways.

Religiousness, including formal religious affiliation and service attendance, is associated with better health habits, such as lower smoking rates and reduced alcohol consumption. Spirituality, including meditation and private prayer, helps regulate emotions, which aids physiological effects such as blood pressure.

The findings were published recently in the journal Psychology of Religion and Spirituality. Co-authors were Crystal L. Park of the University of Connecticut, and Yu-Jin Jeong and Ritwik Nath of OSU. The research was supported by a grant from the John Templeton Foundation.

"No one has ever reviewed all of the different models of how religion affects health," said Aldwin, the Jo Anne Leonard endowed director of OSU's Center for Healthy Aging Research. "We're trying to impose a structure on a very messy field."

There can be some overlap of the influences of religion and spirituality on health, Aldwin said. More research is needed to test the theory and examine contrasts between the two pathways. The goal is to help researchers develop better measures for analyzing the connections between religion, spirituality and health and then explore possible clinical interventions, she said.

Provided by Oregon State University

Spanish and Japanese centenarians reveal a genetic key to longevity

The genes of 894 men and women over the age of one hundred in Spain and Japan have revealed that the secret to longevity, at least in southern Europe, lies in a variant on chromosome 9p21.3, which had already been associated with the risk of cardiovascular disease.

10 may 2014--Centenarians live at least fifteen years longer than the average person in the West. This exceptional longevity is partially genetic.

There are a number of gene variants that may hold the key to a healthy old age life. For example, a polymorphism (that is, a particular sequence variation in the DNA among individuals from a particular population) called rs1333049 on chromosome 9p21.3 is related to chronic ailments associated with ageing, mainly with cardiovascular diseases.

The C allele is the copy of this gene that carries the greatest risk. In order to find out whether this polymorphism is also associated with extreme longevity, Spanish researchers performed an analysis of the frequencies of this polymorphism among centenarians and healthy adults in two independent cohorts, by geographical regions and by ethnic groups.

The study included 152 Spaniards aged between 110 and 111 years and 742 Japanese people aged between 100 and 115 years. The results have been published in the journal 'Age'.

"This variant may be associated with extreme longevity, particularly among the Spanish population," Alejandro Lucía, the main author and researcher at the European University and also a member of the Hospital 12 de Octubre Research Institute, told SINC. "The study also revealed that the risk allele reduces the possibilities of reaching one hundred years of age".

The frequency of the risk C variant in Spanish people over the age of one hundred was 47.0%, lower than in healthy people that were taken as a control sample in the study (52.9%) and individuals with cardiovascular disease (55.1%).

Significant differences were also discovered between the centenarians and the two control groups when their genotype frequencies were compared, in other words, the proportion of individuals with a specific gene sequence.

The results were different in the Japanese group. Among the Japanese participants, the risk gene variant had a similar frequency in centenarians (46.4%) and in healthy controls (47.3%), but it was less frequent than in controls performed withcardiovascular disease (57.2%).

Although the biological mechanisms through which this polymorphism could affect ageing are not known, it is adjacent to two genes called CDKN2A and CDKN2B, which play an important role in cell cycle regulation.

"In fact, the CDKN2A takes part in the p53 signalling pathway, one of the most important ones in the cell senescence regulation," adds Lucía.

Healthy ageing model

"People aged one hundred years or over are not only the peak of the population pyramid," says Lucía. "They also represent a healthy ageing model given that they have delayed, and sometimes even avoided, chronic illnesses that come with age and loss of independence and they tend to be just as health as nonagenarians".

This is why the authors believe it is important to know the genetic or environmental factors that condition the possibilities of reaching this age.

Although more research is required, the information obtained from this study coincides with others published recently on the Mediterranean population of the north of Italy, "therefore the effect of this gene seems to exist in southern Europe at least," concluded the researcher.

More information: Tomàs Pinós, Noriyuki Fuku, Yolanda Cámara, Yasumichi Arai, Yukiko Abe, Gabriel Rodríguez-Romo, Nuria Garatachea, Alejandro Santos-Lozano, Elisabet Miro-Casas, Marisol Ruiz-Meana, Imanol Otaegui, Haruka Murakami, Motohiko Miyachi, David Garcia-Dorado, Kunihiko Hinohara, Antoni L. Andreu, Akinori Kimura, Nobuyoshi Hirose y Alejandro Lucia. "The rs1333049 polymorphism on locus 9p21.3 and extreme longevity in Spanish and Japanese cohorts". AGE DOI: 10.1007/s11357-013-9593-0

Provided by Plataforma SINC